摘要
目的:探索行超声引导下臂丛神经阻滞联合应用右美托咪定时0.375%罗哌卡因的半数有效剂量(ED_(50))。方法:选取择期行肩关节镜手术的患者30例,性别不限,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ级或Ⅱ级。患者入手术室即开始泵注右美托咪定(0.5μg·kg~(-1)·h~(-1)),于超声引导下行肌间沟臂丛阻滞,给予0.375%罗哌卡因首剂量100 mg,后各相邻患者剂量之间的比值为1.2。采用改良序贯法计算0.375%罗哌卡因的ED_(50)及95%可信区间。观察患者的麻醉效果及有无药品不良反应(ADRs)发生。结果:肩关节镜手术患者行超声引导下臂丛神经阻滞复合右美托咪定时0.375%罗哌卡因的ED_(50)为19 ml,95%可信区间为17.5~21.5 ml。ADRs观察发现1例霍纳(Horner)综合征,1例低心率、低血压事件。结论:肩关节镜手术患者行超声引导下臂丛神经阻滞时复合右美托咪定,可减少罗哌卡因的剂量,且麻醉效果好,无严重ADRs发生。
Objective: To investigate the median effective dose(ED_(50)) of 0.375% ropivacaine combined with dexmedetomidine for ultrasound-guided interscalene brachial plexus block(ISBPB) of the patients undergoing arthroscopic shoulder surgery.Methods: Thirty patients who were classified as grade Ⅰ or Ⅱ according to American Society of Anesthesiologists(ASA) and underwent shoulder arthroscopic surgery were enrolled for the study regardless of gender.The patients started to have the pumping of dexmedetomidine(0.5 μg·kg~(-1)·h~(-1)) for ultrasound-guided interscalene brachial plexus block in arthroscopic shoulder surgery when they were admitted into the operating room.The starting dose of 0.375% ropivacaine was 100 mg for the first patient and the ratio between adjacent patients' doses was 1.2.The ED_(50) and 95% confidence interval of ropivacaine was calculated by up-and-down methodology.The anesthetic effect and adverse drug reactions(ADRs) of the patients were observed closely.Results: The ED_(50) of 0.375% ropivacaine combined with dexmedetomidine for ultrasound-guided interscalene brachial plexus block for arthroscopic shoulder surgery was 19 ml and 95% confidence interval was 17.5-21.5 ml.There was one case of Horner syndrome and one case of hypotensive bradycardia event during surgery.Conclusion: Ropivacaine combined with dexmedetomidine in ultrasound-guided brachial plexus block could reduce the dosage of ropivacaine in patients undergoing shoulder arthroscopic surgery,with good anesthetic effect and without severe ADRs.
引文
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